Analysis of Adolescent Idiopathic Thoracic Scoliosis Treated with Posterior Instrumentation and Fusion: Our Experience RC01-RC05
Dr. Abhinandan Reddy Mallepally,
House No-2, Pine Wood Residency, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi-110070, Delhi, India.
Introduction: At present gold standard surgical treatment for progressive idiopathic scoliosis is posterior instrumentation and fusion though there is considerable amount of debate over usage of pedicle screws for their safety in scoliosis surgery on the amount of correction achieved using them and also the need for shorter fusion. Pedicle screw construct gives a three column fixation with better control and enhanced three dimensional corrections, in coronal and sagittal plane.
Aim: To assess the clinical, radiological and pulmonary function results after treating patients with posterior instrumentation using pedicle screws and hooks and to assess the complications.
Materials and Methods: This was a retrospective observational study of 41 Adolescent Idiopathic thoracic Scoliosis (AIS) patients treated with posterior instrumentation and posterior spinal fusion. A t-test to compare preoperative and immediate postoperative Cobbs angle was used. SRS 30 functional scoring system was used to measure the outcome of surgical treatment.
Results: There were 16 males and 25 female patients with age ranged from 11 years to 19 years with average of 13.5 years. The mean preoperative scoliosis is 59Â°Â±15Â°. The mean preoperative kyphosis was 25Â°. The mean postoperative scoliosis is 17Â°Â±10Â° (72% reduction). The mean postoperative scoliosis at two years follow-up was 19Â°Â±9Â° (68% reduction). Correction loss was 30 (14.8%). The mean preoperative FVC was 90.6. The mean preoperative FEV1 was 86.67. The mean preoperative TLC was 97.8. The mean postoperative FVC was 86.2 (p=0.3125). The mean postoperative FEV1 was 85 (p=0.5660). The mean postoperative TLC was 100 (p=0.6671). Thoracoplasty was carried out in 24 patients.
Conclusion: Posterior instrumentation using pedicle screw with or without proximal hook constructs offer improved primary and secondary curve correction in idiopathic scoliosis and with limited fusion of motion segments. Insertion of screws in every single vertebra is not necessary as a satisfactory multidimensional radiological correction and a high long-term patientâ€™s satisfaction can be achieved with a low implant density.